By Laurie L Charlés, PhD, LMFT
AAMFT Clinical Fellow and Approved Supervisor
At the start of the pandemic, I wrote a blog post for the AAMFT website: Five Local and Global things to Remember Now. It was put online March 17th, at the “start,” at least for me, of the Covid-19 pandemic. I had been quite deep in thought about all things global and local when I wrote it, as I was completing a book on working internationally, and multilaterally, as a family therapist. Multilateral, a term more utilized in international politics rather than family therapy, is about collaboration, and about working together across borders and sovereign states on global issues. Systemic thinkers are natural multilateralists—i.e. skilled at lateral engagement, ie. able to work across multiple settings, inclined toward collaboration. Multilateralism is a key part of success to overcoming global issues, as nations must work together alongside each other and across many disciplines to deliver sustainable solutions to their citizens. It is a mindset very much needed in a global emergency.
The pandemic is a global event; indeed, that is what the term pandemic refers to, an epidemic/outbreak of disease across multiple countries and continents. However, as systemic family therapists keenly noted last week at AAMFT 2020--the national conference that broke virtual ground and which I thought was a fabulous success--not everyone’s local pandemic is the same. Your global “zip code” matters, so to speak. Inequities are especially graphic and vivid in complex emergencies, in whatever zip code they occur. A pandemic is just such an emergency, but it is different in Beirut than it is in Boston. Its global universality adds unique layers of specific urgency onto locally pre-existing conditions. Inequities are illuminated in sharp relief. The inequities may appear as if they occurred “overnight;” however, it is only that what is perhaps hidden or less obvious “before” the emergency is more striking and graphic “during,” and most certainly will be, “after.” Systems thinking promotes our ability to understand this figure/ground narrative very well. It is a mindset very much needed to respond to a global emergency.
Where do you “start” your pandemic? At what point in history? For me, it started on March 11th, the day the WHO named it a pandemic. However, for some of my colleagues in Geneva, it was January 30th, 2020, when it was named a PHEIC, a public health emergency of international concern. For a client I saw recently, from Wuhan but now living in the U.S., and whose family is still in China, the start date was late 2019. Yet another client’s pandemic “start” is March 24th, 2020, the day the Commonwealth of Massachusetts established its stay-at-home-order, which meant they could no longer go to work.
Naming the historical moment of a presenting problem’s “start” is a key question for brief systemic family therapists, and a routine practice we’ve shared for decades in the field. Now, when I ask a client’s experience of the pandemic, an orienting question as simple as “How are you doing, right now?” is loaded with meaning. What seems simple is immediately complexified, rightly so, mirroring the global context (and living history) of the client’s response to the emergency. Systemic practitioners are keenly able to address this dichotomy.
In the pandemic’s early days, I was asking clients many questions about their acute health, and the immediate impact of Covid-19 on their work and personal lives. Often, I also asked about their emergency planning. Having lived through a previous PHEIC, I have a ready set of questions about preparedness, response, and recovery. Today, I find I ask more about the lessons learned, so far, at this point in the client’s pandemic process. It is never too early for me to ask about lessons learned; even as the emergency is ongoing, we can talk about how to use what we've learned so far, an individual question to bring to our collective mind to "Build Back Better."
My therapy work is 100% virtual where I live, and although I am licensed in more than one state, most of my clients come from the Commonwealth of Massachusetts, the home of the Boston Marathon, which began in 1897 and now has an average of 30,000 registered entrants each year. Thus, it is not unusual for me to have clients who are marathoners. Yet, I am always awed anew by each one, because of their amazing skill set, discipline, and spirit. One of these clients, during the pandemic, and after the 2020 Boston Marathon cancellation, had to quickly adapt their training plan, because even without the marathon to register for, they knew, for sure, they’d definitely run it again. But marathon training in the dense city of Boston is not easy during a pandemic; my client’s runs could only last four or five miles before their mask became ineffective, or when unmasked humans began invading their space. My client persisted, with great creativity, adapting runs and workouts accordingly to the changing environmental conditions. Although the constraints were new, the client’s goal remained the same: They wanted, most of all, to get to “Mile Twenty.” After that, the 26.2 goal was in sight. As we continued talking through the pandemic, the reference to “Mile Twenty” took on a broader meaning, beyond the Marathon’s starting line at Hopkinton, and as a way to look at how we are globally responding to Covid-19.
And when it comes to “Building Back Better” in my own professional day to day life? I am not yet at Mile Twenty, but I am deeply engaged in the effort to get there. I created something new to work on, a multilateral (international) family therapy exhange project that is both simple and complex at the same time. A colleague and I were awarded a grant to develop guest expert panels to explore how communities are working with family systems to promote psychosocial resilience during the pandemic. So far, we have hosted eight of these panels, with guest experts and colleagues ranging from our respective homes in the U.S. and Sri Lanka, to places as far afield as London and Afghanistan; Windhoek and Guatamela; Libya and Spain and Port-of-Spain; New York City, the Seychelles, Nigeria, and more. From a variety of sectors and disciplines, our panelists share their pandemic view on families and systems from where they live and work. Together, we are learning what global family systems and psychosocial resilience looks like during Covid-19 from many points on the globe. We will continue the conversation until March, 2021. Things will look different then. I look forward to us getting there.
Laurie L Charlés, PhD, LMFT, was a consultant for the World Health Organization Mental Health Response team in Conakry, Guinea, during the Ebola Virus Disease outbreak in 2015. A consultant & trainer for systemic family therapy projects in international humanitarian relief contexts, low and middle-income countries, and conflict-affected states, she is currently Project Lead for Global Family Systems & Psychosocial Resilience, a Rapid Response to Covid19 project funded by the U.S. Department of State. Her forthcoming book, International Family Therapy: Multilateral Systemic Practice in Mental Health and Psychosocial Support, will be published by Routledge later this year.